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Dive into the research topics where Heike Krueger is active.

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Featured researches published by Heike Krueger.


European Journal of Cardio-Thoracic Surgery | 2016

Do not leave the heart arrested. Non-cardioplegic continuous myocardial perfusion during complex aortic arch repair improves cardiac outcome

Andreas Martens; Nurbol Koigeldiyev; Erik Beckmann; Felix Fleissner; Tim Kaufeld; Heike Krueger; Detlev Stanelle; Jakob Puntigam; Axel Haverich; Malakh Shrestha

OBJECTIVES Myocardial protection with cardioplegia alone may be inadequate during complex aortic arch surgery, potentially resulting in postoperative myocardial insufficiency. We hypothesized that non-cardioplegic continuous myocardial perfusion (CMP) is feasible and safe to protect the heart while operating on the aortic arch, and improves cardiac outcome. METHODS Between April 2010 and April 2014, 144 patients (60% male, age: 60 ± 13 years) underwent complex aortic arch repair in our institution using prefabricated, branched aortic arch grafts. In 36 patients, the hearts were protected with a combination of cardioplegic cardiac arrest during cardiac procedures and subsequent non-cardioplegic CMP group during aortic arch repair. In 108 patients, myocardial protection was achieved by cardioplegic arrest (CA group) only. RESULTS Preoperative risk factors were comparable in both groups. Acute aortic dissection was the indication for surgery in 42% (CMP) and 44% (CA) of patients; 22% (CMP) and 29% (CA) of patients underwent reoperations. Concomitant cardiac procedures were similar. CMP patients received a frozen elephant trunk more frequently (89 vs 66%, P = 0.0096). Cardiopulmonary bypass time (242 ± 50 vs 264 ± 68 min; P = 0.046), and cardiac ischaemic time (49 ± 32 vs 149 ± 56 min, P < 0.0001) were significantly lower in the CMP group. There were no conversions to CA in the CMP group. Aortic arch repair was not prolonged by CMP. Low cardiac output syndrome occurred less frequently in the CMP group (3 vs 22%, P = 0.0052). Thirty-day mortality was significantly lower in the CMP group (6 vs 21%, P = 0.040). There were no cardiac deaths in the CMP group (0 vs 9%, P = 0.067). Neurological outcome was comparable. Blood loss was higher in the CA group (P < 0.001). CONCLUSIONS Routinely protecting the heart during complex aortic arch repair with non-cardioplegic CMP is a valuable new concept. The CMP technique is feasible and safe, does not prolong aortic arch repair, reduces myocardial damage and improves cardiac outcome. Further evaluation in a larger patient cohort is warranted to establish this novel technique.


European Journal of Cardio-Thoracic Surgery | 2017

Single-centre experience with the frozen elephant trunk technique in 251 patients over 15 years

Malakh Shrestha; Andreas Martens; Tim Kaufeld; Erik Beckmann; Sebastian Bertele; Heike Krueger; Julia Neuser; Felix Fleissner; F. Ius; Firas Abd Alhadi; Jasmin S. Hanke; Jan D. Schmitto; Serghei Cebotari; Matthias Karck; Axel Haverich; Ajay Chavan

OBJECTIVES Our goal was to present our 15-year experience (2001-2015) with the frozen elephant trunk (FET) technique. METHODS A total of 251 patients (82 with aortic aneurysms, 96 with acute aortic dissection type A, 4 with acute type B dissections, 52 with chronic aortic dissection type A, 17 with chronic type B dissection and 67 redo cases) underwent FET implantation with either the custom-made Chavan-Haverich (n = 66), the Jotec E-vita (n = 31) or the Vascutek Thoraflex hybrid (n = 154) prosthesis. The cases were assigned to an early period (2001-2011) and a contemporary period (2012-present). RESULTS Mean cardiopulmonary bypass time, aortic cross-clamp time, circulatory arrest time and selective antegrade cerebral perfusion time were 241 ± 72, 125 ± 59, 56 ± 30 and 81 ± 34 min, respectively. Incidence of rethoracotomy for bleeding, stroke, spinal cord injury, prolonged ventilatory support (>96 h) and long-term dialysis were 18, 14, 2, 24 and 2%, respectively. The in-hospital mortality rate was 11% (in acute aortic dissection type A, 12%). Of the 2 patients with graft infections, 1 died and the other had a protracted hospital stay. There were 49 second-stage procedures in the downstream aorta: either open surgical [n = 25 (thoraco-abdominal, n = 15; descending, n = 6; infrarenal, n = 4)] or transfemoral endovascular (n = 23). Elective thoracic endovascular aneurysm repair R implantation was successful in all 23 cases. CONCLUSIONS FET results are comparable with those of the published results of the conventional elephant trunk technique. FET is an ideal landing zone for subsequent transfemoral endovascular completion. Patients with graft infections may have dismal results.


European Journal of Cardio-Thoracic Surgery | 2017

Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage

Saad Rustum; Erik Beckmann; Mathias Wilhelmi; Heike Krueger; Tim Kaufeld; Julia Umminger; Axel Haverich; Andreas Martens; Malakh Shrestha

OBJECTIVES Our goal was to compare the results and outcomes of second‐stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease. METHODS Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second‐stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first‐stage procedure. RESULTS The median times to the second‐stage procedure were 7 (0‐78) months in the ET group and 8 (0‐66) months in the FET group. The second‐stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in‐hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow‐up time after the second‐stage operation for the entire cohort was 4.6 (0.4‐10.4) years. The 5‐year survival rate was 76% in the ET patients versus 89% in the FET patients (log‐rank: P = 0.11). CONCLUSIONS We observed a significantly lower in‐hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion.


European Journal of Cardio-Thoracic Surgery | 2018

Valve-sparing aortic root replacement (David I procedure) in Marfan disease: single-centre 20-year experience in more than 100 patients†

Andreas Martens; Erik Beckmann; Tim Kaufeld; Felix Fleissner; Julia Neuser; Wilhelm Korte; Constanze Merz; Heike Krueger; Axel Haverich; Malakh Shrestha

OBJECTIVES Valve-sparing aortic root replacement (VSARR) is recommended for patients with aortic root dilatation and preserved aortic valve cusp morphology. The durability of VSARR in Marfan patients has been questioned. The aim of our study was to establish the long-term outcomes of VSARR in Marfan patients. METHODS Between 1993 and 2015, 582 patients underwent VSARR (David I reimplantation) at our institution. Of these patients, 104 had Marfan disease. Thirteen surgeons performed the procedures in this group. The mean follow-up time was 12 ± 5.4 years (1201 patient-years). RESULTS Early mortality was 0.96%, and long-term survival was 91% at 10 years and 76% at 20 years in Marfan patients. Marfan patients had a significantly better survival compared to non-Marfan patients (P < 0.0001). Freedom from aortic-valve reoperation was 86% at 10 years and 80% at 20 years in Marfan patients. The reoperation rate was similar in Marfan and non-Marfan patients (P = 0.60). Morphological perioperative features (untreated prolapse, commissural plasty, cusp plasty and graft size mismatch) predicted long-term mortality (P = 0.0054). Graft size mismatch and untreated prolapse predicted structural valve deterioration (both P < 0.0001). Long-term valve function in event-free survivors was excellent [mean gradient 4.2 (2.9-6.9), 98% aortic regurgitation ≤ mild]. There were no valve-related thromboembolic or bleeding events. The endocarditis rate was 0.96%. Only 17% of the patients were on oral anticoagulants during the follow-up. CONCLUSIONS VSARR using the David I reimplantation technique results in excellent long-term outcomes in Marfan patients. We present the longest follow-up period so far. The genetic disease does not affect long-term valve function. The durability of the repair is affected by morphological perioperative criteria depending on surgical expertise, and dedicated training is recommended.


The Journal of Thoracic and Cardiovascular Surgery | 2015

The elephant trunk is freezing: The Hannover experience

Malakh Shrestha; Erik Beckmann; Heike Krueger; Felix Fleissner; Tim Kaufeld; Nurbol Koigeldiyev; Julia Umminger; F. Ius; Axel Haverich; Andreas Martens


The Journal of Thoracic and Cardiovascular Surgery | 2016

Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients

Malakh Shrestha; Tim Kaufeld; Erik Beckmann; Felix Fleissner; Julia Umminger; Firas Abd Alhadi; Dietmar Boethig; Heike Krueger; Axel Haverich; Andreas Martens


Annals of cardiothoracic surgery | 2015

Minimally invasive valve sparing aortic root replacement (David procedure) is safe

Malakh Shrestha; Heike Krueger; Julia Umminger; Nurbol Koigeldiyev; Erik Beckmann; Axel Haverich; Andreas Martens


European Journal of Cardio-Thoracic Surgery | 2016

Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques

Julia Umminger; Heike Krueger; Erik Beckmann; Tim Kaufeld; Felix Fleissner; Axel Haverich; Malakh Shrestha; Andreas Martens


European Journal of Cardio-Thoracic Surgery | 2016

Total aortic arch repair: risk factor analysis and follow-up in 199 patients

Andreas Martens; Erik Beckmann; Tim Kaufeld; Julia Umminger; Felix Fleissner; Nurbol Koigeldiyev; Heike Krueger; Jakob Puntigam; Axel Haverich; Malakh Shrestha


The Annals of Thoracic Surgery | 2017

Elective David I Procedure Has Excellent Long-Term Results: 20-Year Single-Center Experience

Malakh Shrestha; Erik Beckmann; Firas Abd Alhadi; Heike Krueger; Fiona Meyer-Bockenkamp; Sebastian Bertele; Nurbol Koigeldiyev; Tim Kaufeld; Felix Fleissner; Wilhelm Korte; Jan D. Schmitto; Serghei Cebotari; Wolfgang Harringer; Axel Haverich; Andreas Martens

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Tim Kaufeld

Hannover Medical School

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F. Ius

Hannover Medical School

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